RESUMEN
OBJECTIVES/HYPOTHESIS: To determine the association of the electrophysiological activity of the pharyngoesophageal transition with tracheoesophageal speech proficiency in total laryngectomees. STUDY DESIGN: An observational (nonexperimental) study of the correlation type with a descriptive approach. METHODS: Thirty-four individuals (26 males), average age 62.5 years, total laryngectomees rehabilitated with the use of a tracheoesophageal prosthesis, were assessed for tracheoesophageal speech proficiency using an adapted protocol and classified as good, moderate, or poor speakers. Next they were submitted to electromyography of the muscles of the pharyngoesophageal transition with a needle electrode. The area to be examined was located by videofluoroscopy. Electromyographic analysis was characterized as normal, neurogenic injury (moderate to severe, severe, severe to total), myopathic injury, or inconclusive. The Fisher exact test was used to determine the association between the speech proficiency variables and electromyography. RESULTS: in the final rating of tracheoesophageal speech proficiency, most laryngectomees were categorized as moderate (n = 24) and a few as good (n = 3). Electromyography revealed neurogenic injury in all laryngectomees, which was severe in most cases (n = 20), followed by severe to total (n = 10), and moderate to severe injury (n = 4). There was no significant association between he electromyographic analyses of neurogenic injuries and tracheoesophageal speech proficiency. CONCLUSIONS: Whether or not the musculature of the pharyngoesophageal transition of tracheoesophageal speakers had a preserved motor unit, did not prevent voice acquisition and was not associated with tracheoesophageal speech proficiency. However, further studies are needed in this area. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:1369-1375, 2017.
Asunto(s)
Electromiografía/métodos , Esfínter Esofágico Superior/fisiopatología , Laringectomía/efectos adversos , Laringe Artificial , Voz Esofágica/instrumentación , Estimulación Eléctrica/métodos , Esfínter Esofágico Superior/diagnóstico por imagen , Esfínter Esofágico Superior/lesiones , Femenino , Fluoroscopía , Humanos , Laringectomía/métodos , Laringectomía/rehabilitación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Habla/fisiología , Voz Esofágica/métodos , Calidad de la Voz/fisiologíaRESUMEN
Los divertículos faringoesofágicos o de Zenker, son los más frecuentes de los divertículos por pulsión, constituidos por la protución de la mucosa de la faringe a través de un defecto de la pared posterior de ella, entre los músculos constrictor inferior de la faringe y el cricofaríngeo. Se realizó un estudio de 14 pacientes intervenidos quirúrgicamente por esta afección con seguimiento entre 2 y 14 años, divididos en 2 series, una de 5 pacientes a los cuales se les realizó diverticulopexia a uno y a los otros diverticulectomía, y otra serie de 9 pacientes en los que se efectuó diverticulectomía con cricomiotomía. La halitosis (100 porciento), disfagia (85,7 porciento) y regurgitación (57,1 porciento) fueron los síntomas que mayormente se hallaron. Se corroboró el diagnóstico en todos los casos con un estudio baritado de esófago, estómago y duodeno. Los resultados a largo plazo fueron altamente satisfactorios en 11 pacientes, regulares en 2 y malos (recidiva) en 2. El tratamiento de elección fue la diverticulectomía con cricomiotomía(AU)
The pharyngo-oesophageal or Zenker´s diverticula are the most frequent pulsion diverticula produced by a protrusion of the mucous membrane of the pharynx through a defect of its posterior wall between the inferior constrictor musclessof the pharynx and the cricopharyngoeal muscle. A study of 14 patients who underwent surgery due to this affection and were followed-up from 2 to 14 years was conducted. They were divided into 2 groups: one of 5 patients among whom one underwent diverticulopexy and the diverticulectomy with cricomyotomy. Halitosis (100 percent), dysphagia (85.7 percent) and regurgitation (57.1 percent) were the most commonly found symptoms. The diagnosis was confirmed in every case through a barium study of the esophagus, the stomach and the duodenum. The results on the long term were highly satisfactory in ll patients, fair in 2 and bad (relapse) in 2. The election treatment was diverticulectomy with cricomyotomy(AU)